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Account#: 121165 <br /> PARK <br /> Imo. IDENTIFICATION <br /> BUSINESS NAME (4) TWO RIVERS R.V. PARK I BUSINESS PHONE(5) 209-825-1079 <br /> SITE ADDRESS (6) 31021 ❑ TWO RIVERS <br /> Street No. Direction Street Name Street T e Apt/ld Suite <br /> CITY (7) CA MANTECA STATE(8) ZIP(9) 95337-9468 <br /> DUN& (10) 609984211 SIC CODE(4 DIGIT#)(11) 7033 <br /> BRADSTREET <br /> OPERATOR (12)GEORGE TURKMANY OPERATOR PHONE(13) 209-823-8434 <br /> NAME <br /> II.BUSINESS OWNER <br /> OWNER NAME(14) GEORGE TURKMANY OWNER PHONE(15) 209-823-8434 <br /> OWNER MAILING ADDRESS(16) 31021 TWO RIVERS RD. <br /> (If different from site address) <br /> CITY(17) MANTECA STATE(18) CA ZIP(19) 95337-9468 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) DEBORAH K TENNANT CONTACT PHONE(21) 209-825-1079 <br /> MAILING ADDRESS(22) <br /> (If different from business 31021TWO RIVERS RD SP#4 <br /> mailing address) I IF <br /> Street No. Direction Street Name Street T e A t/Bld Suite <br /> CITY(23) EANTECA :::] STATE(24) El <br /> ZIP(25) 95337-9468 <br /> Primary IV. EMERGENCY CONTACTS Secon <br /> NAME(26) DEBORAH &TENNANT NAME(3 1) GEORGE TURKMANY <br /> TITLE(27) MANAGEMENT TITLE(32) OWNER <br /> BUSINESS PHONE(28) 209-823-8434 BUSINESS PHONE(33) 209-823-8434 <br /> 24-HOUR PHONE(29) 209-823-8434 24-HOUR PHONE(34) 209-823-8434 <br /> PAGER#(30) N/A PAGER#(35) N/A <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) YES If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment involving the EHS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER(38) DEBORAH K. TENNANT <br /> NAME OF OWNER/OPERATOR(39) GEORGE TURKMANY DATE(40) <br /> DATE REC'D: 3/10/04 <br />